Organization
MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF WINTER PARK, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE GOMEZ (CREDENTIALING SUPERVISOR)
(305) 274-2499
Entity
Organization
Contact information
Practice address
501 N ORLANDO AVE STE 233, WINTER PARK, FL 32789-2947
(407) 622-1000
Mailing address
13195 SW 134TH ST FL 2, MIAMI, FL 33186-4461
(305) 274-2499
(305) 274-9312
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN5380
FL
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
05/13/2011
Last updated
07/21/2022
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